@nourishingapothecary: If you’ve started experiencing urinary tract infections during perimenopause, there may be an important hormonal connection that hasn’t been explained to you. And it has a lot to do with oestrogen. Most women associate oestrogen with their menstrual cycle, fertility and menopause symptoms. But oestrogen also plays an important role in maintaining the health of the vagina, vulva, urethra and bladder. As oestrogen levels become more variable and eventually decline through the menopausal transition, several changes can occur. Firstly, your vaginal microbiome can change. Oestrogen helps vaginal epithelial cells accumulate glycogen, which supports an environment where beneficial Lactobacillus bacteria can thrive. These bacteria produce lactic acid, helping maintain the normally acidic vaginal environment. Why does that matter? Because this environment provides an important defence against potentially harmful bacteria, including E. coli, one of the most common causes of urinary tract infections. When oestrogen declines, Lactobacillus dominance may decrease and vaginal pH can increase, potentially making it easier for certain bacteria to colonise. Secondly, the vaginal and urinary tissues themselves can change. Oestrogen helps maintain the thickness, elasticity and moisture of vaginal tissues. With declining oestrogen, these tissues can become thinner, drier and more fragile. These changes are associated with a condition called genitourinary syndrome of menopause, or GSM. And this is where things become particularly interesting clinically. Not every woman experiencing UTI symptoms actually has a bacterial infection. GSM can cause symptoms that feel remarkably similar to a UTI, including: * Burning or discomfort when urinating * Increased urinary frequency * Urgency * Vaginal irritation and dryness So a woman may experience repeated episodes of urinary discomfort and assume she keeps developing infections, when hormonal changes to the genitourinary tissues may also be contributing. This is why I place so much importance on investigating recurrent urinary symptoms properly. If someone tells me they’ve suddenly started experiencing recurrent UTIs, I want to know: Are these infections being confirmed with urine cultures? Which bacteria are being identified? Are the symptoms resolving completely between episodes? Are there associated symptoms of vaginal dryness, irritation or discomfort during intercourse? And has this started alongside other perimenopausal changes? A urine culture can help identify bacterial infection and guide appropriate treatment, particularly when symptoms are recurrent. There’s also an important treatment option more women should know about: vaginal oestrogen. For peri- and postmenopausal women with recurrent UTIs associated with declining oestrogen, local vaginal oestrogen is an evidence-based option that can help reduce recurrence. It works locally on the genitourinary tissues and is different from taking systemic menopausal hormone therapy. It isn’t appropriate for everyone, so individual assessment with a GP is important. And of course, a confirmed bacterial UTI still requires appropriate medical treatment. Fever, flank pain or feeling significantly unwell warrants urgent medical assessment. The important message is that recurrent urinary symptoms during perimenopause shouldn’t simply be dismissed as something women have to tolerate. There may be several contributing factors, and understanding the underlying physiology helps us investigate and manage them appropriately. At Nourishing Apothecary, our perimenopause naturopath Toni works with women experiencing hormonal, urinary and vaginal changes throughout the menopausal transition. Book a free discovery call with Toni to discuss your concerns. Consultations are available Australia wide via Zoom. www.nourishingapothecary.com #perimenopause #recurrentuti #vaginalhealth #menopause #womenshealth

Jaime | Naturopath & Homeopath

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Sunday 01 November 2026 23:07:19 GMT